Should Type 2 Diabetics go keto?

OK, let’s talk about what a ketogenic way of eating is and why it is being credited with the remission and even reversal of Type 2 diabetes.

What does “keto” mean anyway?

“Keto” refers to “ketogenic” which means “ketone producing”. What are ketones? Ketones are the byproducts of fat metabolism in our body. Most of the cells in our body can use ketones or glucose for energy – we are the original hybrid engine! If we are producing ketones in measurable amounts, we are said to be in “ketosis”. Nutritional ketosis refers to a safe level of ketones in the body. A dangerously high level of ketones, called ketoacidosis, usually only occurs in Type 1 diabetics with uncontrolled blood glucose or as an adverse effect of some medications.

A rose by any other name…ketogenic diets may also be referred to as very-low-carb, LCHF (low carb high/healthy fat), Atkins Induction phase…

So how does one get into ketosis? And why would I want to?

Ketosis, or the presence of ketones, occurs when blood sugar (glucose) levels are low, allowing circulating levels of the hormone insulin to decrease. Only when insulin levels are low can our bodies have access to our fat stores to use as energy. Access to our fat stores means we are fat-burners instead of sugar-burners. If we’re only able to use the sugar we ingested in our last meal, we run out of energy quickly and can get “hangry” when our blood glucose levels drop. When we are in fat-burning mode energy is constant; it’s not dependent on what we ate or how long since our last meal.

How to get your blood glucose to go down low enough for ketosis? Decrease your carbohydrate intake – to around 20 grams per day. If carbohydrates are very low, insulin will decrease and that decrease in insulin will allow your body to burn fat. It’s not an instantaneous conversion, and it may result in a temporary decrease in energy – but our bodies know what to do, they will burn what they are given. In this case, you cut the carbohydrates way down, and increase the fat in your meals, protein stays at moderate levels.

Nutritional ketosis for someone with Type 2 diabetes means their blood sugars are low enough to allow their bodies to use fat for energy instead of sugar. Upon adopting a ketogenic way of eating, blood sugar readings should decrease rapidly as glucose in the blood and glycogen in the muscles and liver is depleted. As this effect can be pretty quick, it’s important to check with your physician about how to manage diabetes medications when changing your diet.

Dr. Sarah Hallberg, now of Virta Health, gave an excellent TED talk about the use of diet in reversing Type 2 diabetes back in 2015. The evidence for the effectiveness of a ketogenic diet has only increased in the past four years.

From the 2019 Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report from the American Diabetes Association: (sections in bold – my added emphasis)

The amount of carbohydrate intake required for optimal health in humans is unknown. Although the recommended dietary allowance for carbohydrate for adults without diabetes (19 years and older) is 130 g/day and is determined in part by the brain’s requirement for glucose, this energy requirement can be fulfilled by the body’s metabolic processes, which include glycogenolysis, gluconeogenesis (via metabolism of the glycerol component of fat or gluconeogenic amino acids in protein), and/or ketogenesis in the setting of very low dietary carbohydrate intake (49).

The National Academy of Medicine has defined an acceptable macronutrient distribution for total fat for all adults to be 20–35% of total calorie intake (49). Eating patterns that replace certain carbohydrate foods with those higher in total fat, however, have demonstrated greater improvements in glycemia and certain CVD risk factors (serum HDL cholesterol [HDL-C] and triglycerides) compared with lower fat diets. The types or quality of fats in the eating plans may influence CVD outcomes beyond the total amount of fat (63). Foods containing synthetic sources of trans fats should be minimized to the greatest extent possible (8). Ruminant trans fats, occurring naturally in meat and dairy products, do not need to be eliminated because they are present in such small quantities (64).

Consensus recommendations
A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:
○ Emphasize nonstarchy vegetables.
○ Minimize added sugars and refined grains.
○ Choose whole foods over highly processed foods to the extent possible.
Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

These sections from the ADA report show a huge change from previous ADA recommendations. The evidence is in (and more is coming) that a LCHF or ketogenic way of eating is an effective and healthy way to treat and possibly reverse Type 2 diabetes! There are many “bonus” effects of keto, not the least of which is comfortable, hunger free weight loss.

Let me be clear, I’m not a doctor or other licensed medical professional. Please use your own judgement and consult with your doctor before making dietary changes that may affect your health, especially if you are currently taking prescription medications.

Thanks for reading and please comment or contact me directly with questions.

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